When it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.The researchers concluded: “Individuals with higher stigma toward peoplewho use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseaseslike hepatitis C and HIV, cutdown on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.John Brooklyn, a chief architect of the hub-and-spoke system, referred to perceptions of evidence-based anti-addiction medications like buprenorphine as an example: “It’s now 14 years after buprenorphine’s been approved [by the Food and Drug Administration], and you still have an awful lot of docs — you even have our [former] secretary of health and human services — who [say] medication-assisted treatment is just a crutch.”Or consider one of the emails I received in response to a story on opioids: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”TO CONTINUE READING:hen it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.The researchers concluded: “Individuals with higher stigma toward peoplewho use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseaseslike hepatitis C and HIV, cutdown on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.TO CONTINUE READING: https://www.vox.com/science-and-health/2018/6/7/17434480/needle-exchange-safe-injection-site-stigma-study

​The deaths of the designer Kate Spade and the chef Anthony Bourdain, both of whom committed suicide this week, were not simply pop culture tragedies. They were the latest markers of an intractable public health crisis that has been unfolding in slow motion for a generation.Treatment for chronic depression and anxiety — often the precursors to suicide — has never been more available and more widespread. Yet the Centers for Disease Control and Prevention this week reported a steady, stubborn rise in the national suicide rate, up 25 percent since 1999.The rates have been climbing each year across most age and ethnic groups. Suicide is now the 10th leading cause of death in the United States. Nearly 45,000 Americans killed themselves in 2016, twice the number who died by homicide.After decades of research, effective prevention strategies are lacking. It remains difficult, perhaps impossible, to predict who will commit suicide, and the phenomenon is extremely difficult for researchers to study.One of the few proven interventions is unpalatable to wide swaths of the American public: reduced access to guns. The C.D.C. report found that the states where rates rose most sharply were those, like Montana and Oklahoma, where gun ownership is more common.It is predominantly men who use guns to commit suicide, and men are much less likely to seek help than women.The escalating suicide rate is a profound indictment of the country’s mental health system. Most people who kill themselves have identifiable psychiatric symptoms, even if they never get an official diagnosis.The rise in suicide rates has coincided over the past two decades with a vast increase in the number of Americans given a diagnosis of depression or anxiety, and treated with medication.The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000.TO CONTINUE READING: https://www.nytimes.com/2018/06/08/health/suicide-spade-bordain-cdc.html?emc=edit_th_180609&nl=todaysheadlines&